Primary care can improve hygienic practices while reducing waste

Background & Goal: Exam table paper is perceived as necessary for hygienic care; however, there is limited evidence for its efficacy. It may not stop disease transmission, and it may create a false sense of cleanliness. The Ontario Guidelines for Prevention & Control of Infection in Healthcare Settings do not endorse exam table paper, but rather recommend cleaning with specific low-level disinfectants (for example, 0.5% accelerated hydrogen peroxide). Additionally, there are negative economic and climate change impacts of using exam table paper. The average clinic seeing ~100 patients per day spends ~$75-$90 CAD (~$55.40-$66.50 USD) per week on exam table paper. Exam table paper contributes to the environmental impact and carbon footprint of the health care industry. 

Study Approach: Exam tables were covered with exam table paper according to usual practices, which leaves about 25% uncovered. Study participants in the ‘patient’ role spread the liquid form of the fluorescent product Glo Germ^TM across both of their palms. They then received one of three common exams seen in family medicine clinics—knee/hip, cardiorespiratory, or abdominal—by a resident physician in the ‘doctor’ role. Black UV light was used to identify areas of the exam table with Glo Germ^TM. These steps were then repeated with exam tables that were not covered with exam table paper.

Results: Whether or not exam table paper was present, patient-role volunteers more frequently touched the areas of the table that are not typically covered with exam table paper (i.e. the sides).

Why It Matters: The economic and environmental costs of exam table paper cannot be overlooked. A reduction in exam table paper use may mitigate this field’s environmental impact, carbon footprint, and unnecessary clinic spending. Additionally, hygienic maintenance of exam tables can shift from reliance on exam table paper to low-level disinfectants. Exam table paper may still be beneficial in certain sensitive exams (rectal/genital/pelvic) and vulnerable populations (newborns and the elderly). The study has limitations, in that it did not consider the economic and climate costs of using low-level disinfectants. 

Does Examination Table Paper Use Mitigate the Risk of Disease Transmission in a Family Medicine Clinic?

Nathan Chiarlitti, MD, et al

Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada

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